Nasal fractures, and more broadly nasal injury, can present themselves in a wide variety of ways– it is not always as simple as a broken nose. Depending on the timing, the nature of the injury, and other associated issues, facial fractures may be treated differently.

  • Nasal injuries can present themselves in a multitude of ways
  • It is important to be seen by a specialist with the expertise and experience to understand the nature of your injury and determine the best evaluation and treatment
  • Nasal bone fractures are one of the most commonly fractured bones in your body and so our practice is experienced at seeing such injuries frequently.

What is a Nasal Fracture?

A nasal injury may be acute, meaning, recent, and still healing, or it could be old. Moreover, there are deformities or functional abnormalities, as a result of poor healing, or inadequate treatment that distinguish fractures further apart.

For this reason, it may be helpful to first understand some basic anatomy as to what may be injured. Internally, your nose has several structures that affect its shape, including the nasal bones in the upper third of the nose. The lower 2/3 of the nose includes cartilage of the nasal bridge and cartilage of the tip. Underneath all this and inside your nose is the nasal septum– a wall that divides the left and right nasal passageways. See the diagram for reference on this.

During an initial exam of the nose, the surgeon will evaluate for structural abnormalities of the nose, externally, and internally. A visible shifting of the structures may indicate an external deformity. Internally the septum may be deviated or could even have a hematoma that might need treatment. Nosebleeds are also an issue that sometimes might need treatment or intervention. Ideally, the best timing for an evaluation after a trauma is about 3 to 7 days after the injury. Sometimes there is so much swelling initially and the exam is not as ideal. X-rays have limited value, but sometimes the doctor may want a CAT scan if they suspect other injuries associated with this. Nonetheless, the physical exam is an important and top priority.

What Patients Are Saying

I have been dealing with extremely weird problems with my right ear for about two and a half months. After being ignored at my regular physicians office, I decided to see Dr. Schwartz ( Swartz) and I am so happy I did. The hearing test was thorough and I received the results immediately after which gave me relief. The assistant was so nice and made me feel like she was truly listening to me. I loved how she relayed everything to the doctor before he came in. Because of this, He gave me answers and set up a game plan immediately. I have never felt so taken care of! I truly felt important and heard. Thank you everyone in the office for being so amazing!

Great staff. Got me in right away. Dr. Griffin is great.
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How is a Nasal Fracture Procedure Done?

Nasal fracture management can vary quite a bit, depending on the extent of facial trauma, the anatomy of the nasal bone, the structures that are affected by the injury, participation in contact sports, and other risk factors. No matter the extent of facial injuries, the goal of any nasal fracture reduction includes minimizing secondary nasal deformities.

Most nasal fractures and injuries require no intervention but monitoring and pain medication for appropriate healing. This would be the case when a patient has a non-displaced facial fracture where the bones have not fallen out of position.

The simplest nasal fractures are the common, mildly displaced, nasal bone fracture that requires early adressal and treatment. A closed reduction is a procedure where an instrument is placed in the nose to simply reposition the nasal bones back into the original position. This usually should be attempted within the first few weeks of the injury.

A larger nose fracture will benefit from a procedure technique called an open reduction. This is when incisions are made to get better access to the damaged structures– a variety of instruments are used to either reopen fractures or reposition structures and repair the nose. Sometimes this is done in conjunction with repairing a deviated septum, called septoplasty.

When the complex cartilage structures are severely damaged and reconstruction of these areas of the nose is needed, then the surgeon may employ the most complex techniques of rhinoplasty surgery. Rhinoplasty surgery refers to the reshaping of the nose and is related to surgery on the external structures of the nose.

Nasal fracture repair can be done in several different settings, including under local anesthesia in the clinic, but is more often done in an outpatient surgery setting under general anesthesia. For a simple closed reduction, the patient may appreciate the convenience of having it done in the office with local anesthesia, but many patients prefer a brief general anesthesia to repair the nose as well.

Nasal Fracture Recovery

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Most complex nasal fracture repairs are done while the patient falls asleep under anesthesia. When they awaken, they typically will have a protective outer cast or splint, and sometimes some internal splints as well. Patients in our practice have any major, packing or gods put in the nose. After recovering from anesthesia, they will return home and rest, most people need 2 to 5 days off for recovery and then are gradually returning to their usual activities. The cast that’s on your nose will typically be there for one week. At your one-week appointment, the surgeon will inspect the nose and give you an idea of what needs to be done for ongoing care and expectations for healing.

Some limitations are typically imposed after a nasal fracture repair. Typically, we do not advise the patient to engage in strenuous exercise or heavy lifting for about two weeks. We also recommend you avoid airplane travel for about two weeks. Other activities in which you could injure your nose may include contact sports and should be restricted for at least 6 to 8 weeks. Protective measures such as facial masks are helpful but are not a guarantee of not re-injuring your nose.

Contact the AOO/ENT specialists of the Rockies today to schedule your appointment in Denver or Lone Tree, Colorado.

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Sources:

  1. www.aafprs.org
  2. www.facs.org
  3. www.entnet.org

Christopher R. Cote, M.D.

With more than 25 years experience,Dr. Christopher Cote is double-board-certified by the American Board of Otolaryngology and the American Board of Facial and Reconstructive Surgery. He received his medical degree from Tufts University and performed a surgical internship and residency at Walter Reed Medical Center and National Naval Medical Center. He received fellowship training at Johns Hopkins University in Facial Plastic And Reconstructive Surgery, his subspecialty area of expertise and focus, including rhinoplasty and nasal airway surgery . He also enjoys hiking, skiing, and traveling with his family.

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